P - 75900�9 REQUEST FOR ELECTRICAL INSPECTION ��"`
1��`� �� 4 3�� Minnesota Board of Electricity
1821 University Avenue Su'de S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1�00-627-3529 www.edectricity.state.mn.us
Describe - the t�ck of the y ff Nt work covered by this
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GENERAL F S Outdoor Liahtirm Stand C� $1
✓ICES / POWER SUPPLIES
0 to 400 Amaere C� $25
tM, COMMUNICATION, REMOTE CONTROL,
,UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Sastem Device or Aooaratus C� $.50
Unit @
)DRIONAL FEES
Fodure
Transformers u to 10 KVA $10
Transformers aver 10 KVA � 20
Transformer / Power Su I for S' s/ Outline Li hti $5
ONE & TFNO FAMILY DWELLINGS, EACH UNIT
Ir�cludes the Service and/or Power Supply up to 500 Amper�, AO
Cirarits and Two Inspection Trips Each Dwelling Unit @$80
Additionallns anT' $20
Imrestl ative Fee
Reins 'on Fee $20
TOTALFEE
(minimum total fee is $20)
nw naen wa u�croR usE w�ar
I hereby certlfy that I inspected fhe etectrial inslalla8on des�xf6ed herein an the detes ateted:
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TIi151NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT CQMPLETED WITHIN 42 MONTHS
FQR OFF4CE USE ONLY
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�' Rough-in Inspectlon Requh�T ❑ Yes ❑ No Inspe�Uon Other Than Rough-In: Ready Now O Wi0 Cell
��(Jl '� You must call the inspector when ready! Date Ready:
I cefify that l am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER arM hereby request inspection of the el�trical work at
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